Provider Demographics
NPI:1508558248
Name:ROGALNY, JESSICA LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:ROGALNY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 SW IDOL AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6727
Mailing Address - Country:US
Mailing Address - Phone:561-317-3198
Mailing Address - Fax:
Practice Address - Street 1:3375 20TH ST STE 140
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2454
Practice Address - Country:US
Practice Address - Phone:772-299-7299
Practice Address - Fax:772-563-9191
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11026508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily